Throughout the United States, the legalization of marijuana is being debated by the public and in government forums. Although still criminalized at the federal level, decriminalization at the state level has received national attention because several states have enacted marijuana legislation for medical and recreational purposes. As of 2013, 18 states and the District of Columbia have passed legislation allowing for the use of medical marijuana, which includes many edible products, and sales are projected to more than double by 2015. More recently, Washington and Colorado have decriminalized small amounts of recreational marijuana. In 2004, the American Academy of Pediatrics released a policy statement that expressed concern about potential abuse of marijuana among adolescents in the context of decriminalization. There has been some evidence of medical marijuana being diverted to adolescents and recent reports of marijuana exposure to younger children. Studies suggest that there has been a slight increase in symptomatic, unintentional marijuana exposures since 2009. “Most of these exposures were from medical marijuana, which was often packaged as food products,” explains George S. Wang, MD, FAAP. “As such, it’s important to examine the effect that decriminalizing marijuana has had on children.” Assessing Trends in Marijuana Exposure In a study from Annals of Emergency Medicine, Dr. Wang and colleagues compared trends in unintentional marijuana exposures to children up to the age of 9 as measured by call volumes that were reported to U.S. poison centers. The authors hypothesized that decriminalized and transitional states would experience greater increases in call volume and have more symptomatic exposures and healthcare admissions than non-legal states. “States that decriminalized marijuana had significant increases in...

Over the last few years, research has shown that abuse of synthetic drugs is becoming more common throughout the country. In response to this, the United States Drug Enforcement Agency has listed an increasing number of synthetic cannabinoids (SC) as Schedule 1 substances, and Congress has passed the Synthetic Drug Abuse Prevention Act. “SC products have received substantial media attention for being sold as legal highs,” explains Patrick M. Lank, MD. Common SCs include “Spice” and “K2,” and these drugs are often packaged as incense. Tough Spot for EDs Complications from SC use have led to an increase in hospital visits, particularly for EDs. “The initial growth of SC use in the U.S. was sparked by reports that they had effects similar to marijuana,” says Dr. Lank. “An added advantage was that they were thought to be undetectable on routine urine drug screens and were widely available by legal public consumer means. We have learned over time that the clinical effects of SCs are quite different from those caused by smoking marijuana.” There is growing concern for the potential of long-term immunologic, neurologic, and psychiatric complications with SC use, specifically in adolescents. Dr. Lank says emergency physicians (EPs) are in a particularly difficult position as the use of new synthetic drugs increases in popularity. “EPs often must treat patients who abuse SCs despite having relatively little knowledge of these substances,” he says. “Considering the increasing popularity of SCs, it’s important to assess EP knowledge of these designer drugs and explore ways to optimize care for patients presenting to EDs after exposure to these drugs.” New Data & Insights In...

The Particulars: Research suggests that short-term marijuana exposure is associated with brochodilation. Long-term exposure has been shown to increase respiratory symptoms. The effects of marijuana smoking on long-term outcomes for patients who present to EDs with severe asthma exacerbations is not well known. Data Breakdown: Researchers compared outcomes at 12 weeks following asthma-related ED visits for marijuana smokers with those of non-marijuana smokers. Marijuana smokers were more likely to experience one or more exacerbations than non-marijuana smokers (59% vs 29%). Marijuana smokers also had an average exacerbation rate of 3.98 per year, compared with 1.96 per year for non-marijuana smokers. Take Home Pearl: Patients who smoke marijuana appear to experience more asthma exacerbations following asthma-related ED visits than those who do not smoke the illicit...